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Anterior Shoulder Dislocation. 17 year old basketball player Diving for basketball with arm outstretched Players landing on his posterior shoulder while he was gaining control of ball The resulting pressure from posterior resulted in subcoracoid(anterior) dislocation - PowerPoint PPT Presentation
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Anterior Shoulder Dislocation
17 year old basketball player
Diving for basketball with arm outstretched
Players landing on his posterior shoulder while he was gaining control of ball
The resulting pressure from posterior resulted in subcoracoid(anterior) dislocation
90-95% are Subcoracoid(ant) or Subglenoid(ant/inf)
Didn’t see injury
Was in Training Room at time taking care of another athlete
Player presented himself to training room with arm held over stomach area
Player stated arm was numb and couldn’t moveit
The Real Issue
Player- Father in Armed Forces
Legal guardian was grandparents- not at gamePlayer asked that I reduce shoulder to prevent
issues at homeAthletic Director was present at game- agreed
Athlete and AD relationships
Knew of the players issues at homeVery good relationship with ADKnow the family/parents when canDon’t sit in the Training Room or the corner of
the gym in isolation
Typical Protocol
Will place injured athlete in sling or ace wrap arm to side
Place ice over shirt or wrapSend to ER for x-raysPossible issues-- bony injuries, fractures,
ligament injuries, neuro damage
What did I do
Check pulse and neuroPalpate shoulder area- clavicle, scapula for any
obvious FXPalpate humeral head for position/ where is it atCheck shoulders bilateral
How did I reduce?
Placed athlete prone on stomach/tableApplied 4-5 lbs of manual tractionShoulder reduced within one minuteSubtle click or visible movement back into
glenoid fossa
After Reduction
Check pulse and neuroPalpate shoulder anatomy to check for symmetryPlaced in sling and applied IceSent home athletic instructions of what to look for
and call me if any issuesRecheck the athlete daily basisAsked legal guardians to call me- Never did
Follow-up care
After a few weeks we started ROMProgressed into shoulder strengtheningAthlete ran track in spring with no complaintsOf course don’t forget to document and sit with
AD to fill out paperwork
Know the athletes/AD
Speak with the kids when the come into the training room
Get on the same page with AD and know the school policies
Football Player/Dislocated Shoulder
Athlete was part of a group of players tackling ball carrier
The play ended out of bounds with about 6 players involved
Was about 20 yards awayAt the end of the play one player remained on his
back
Walking upon the player/injury
Player was in supine position with arm on ground outstretched and elevated- chewing on mouth piece
All UE anatomy looked to be normal
I think my arm fell off!
Was his first wordsStated his arm was numb and hoped it was still
onI reassured that it was still on
Evaluation under shoulder pads
Palpate bilateral shoulder/CervicalLooking for Scapula FX, Clavicle FX, AC JT,
Humeral Head, Cervical SpineCheck elbow, hand and wristCheck for blood and neuro responsesTrust what you feel
Humeral Head felt like in armpit
After palpation determined dislocated shoulder
And then the wait began
Will usually rotate this back in position, resting arm on stomach and wait for parents to come down from the stands.
No parent at the gameGood relationship with AD- Policy was that
players could not be transported/ambulance without parent knowledge
Stuck dislocated shoulder
Attempted to gently rotate arm into resting position on stomach
Arm would not move/ don’t force rotationAttempted to locate parent at home– No LuckWe waited about 15 minutes with Ice on shoulder Monitor UE vital signs
AD finally made call
Because of no obvious true emergency we waited approx 20 minutes to call Ambulance
The issue was with parents being very upset with medical bills caused by sports and not being able to pay
The AD was willing to take the responsibility of dealing with the aftermath.
Didn’t remove shoulder pads
Due to the shoulder being stuck in ext rotation and abduction/didn’t want to injury any further.
Ambulance arrived and had to transport with shoulder in that position
Get to know the AD and discuss policies so you are on the same page.
Document
Called AD re injury so we both documented
The ring finger vs logic
Football player- finger stuck in opponent players face mask
Finger will go where the opponents facemask goes
Resulting in loss of continuity between the two joints– aka- dislocated finger
Visible appearance
Usually obvious-- crooked finger, laterally or resting on top on proximal joint
Palpate carpal, metacarpal, phalangesOnce determined that FX is usually not an issue
will reduce. Buddy tape and will play.
How to Reduce
Usually players are sweaty from participationGauze works will because of the rough surface
place a gauze pad over proximal, middle phalanx or metacarpal
Place a separate piece of gauze over the dislocated joint
Grasp proximal phalanx or metacarpal firmlyGrasp dislocated phalanx firmlyLift or pull dislocated finger away from joint–
Up/Down or SideThen pull dislocated finger forwardFinger should slide into placeCheck ROM, blood supply, neuro and splint
Fran VS The Ring Finger
After attempting to reduce in this manner the finger would not budge
Then I tried put more force/pull into the effortThen I put more more force/pull into the effortFinger would not budge
Doctor VS The ring finger
Home team doc arrived upon the sceneAttempted to reduce Then attempted to reduce againThen attempted to reduce againThe finger Won. We had to splint in the
dislocated position and send to ER with parents
The reason we lost the battle
Because of the violent twisting and pulling of the joint, soft tissue/ligament had gotten caught between the joint
Other Issues with Dislocated FingersCommon to have small fractures Sometimes they when reduced they don’t stay in
place. FX
Pseudoarthrosis Clavicle
Original thought to be a matchstick fracture due to pressure from birth canal.
History
Rare Etiology Unknown—Subcalvian Artery saws
through during development? Most are occur on right side. No hx of trauma or tenderness.
Shoulder Deformity
Normal ROM Normal Strength Slight Depression or forward rounding of
shoulder at 9 years old. Very Mild Lower Scapular Winging.
Treatment Options?
Surgery? Risk of infection Will bone graft heal/area of poor circulation Is it worth the price? History of surgery plate breaking Other technique is a K wire through bone
Clavicle Pseudoarthrosis Complications
Infection Nonunion Brachial Plexus Injury Rare Complications-- Pain at Site, Shoulder
Asymmetry, Decreased ROM, Thoracic Outlet Syndrome.
What are we doing?
Consulting with Dr Latz Recommend NO SURGERY